This Clinical Mental Health Academic Award will support the Principal Investigator's development as an academic geriatric psychiatrist. The broad investigative focus is on the relationships between medical illness and depression in the elderly. It is anticipated that this work will improve understanding of pathogenetic mechanisms in late life depression. A crucial part of these efforts is the new research proposal described in the application: two coordinated projects that examine the relationships between specific medical illnesses, i.e., cerebrovascular risk factors, and depressive symptoms and syndromes in a primary care medical outpatient setting. These studies will test the theory that these systemic disorders influence depression via small vessel brain disease, as opposed to other routes that involve the mediating roles of functional disability, pain, and personality and psychosocial factors. The PI will utilize formal course work, independent study, expert consultation, and collaborative/mentoring relationships with others to facilitate his emergence as an independent investigator, teacher, and resource for younger researchers. Inherent to the development plan (including both educational activities and the research projects) is the acquisition of knowledge and skills that span between geriatric psychiatry and the larger fields of gerontology and geriatric medicine. The Department of Psychiatry, University of Rochester School of Medicine and Dentistry, enthusiastically supports this application, given both its strong commitment to the PI, and its need to establish new research at the interface between medical illnesses and late life mood disorders.